Forces come from all directions to affect health care

FORT COLLINS — The forces bearing down on the health-care industry are coming from all directions — from lawmakers to giant medical conglomerates seeking to gain even larger shares of the market. And the solutions aren’t always clear.

Health-care executives met Tuesday morning at the Northern Colorado CEO Roundtable for health-care executives, a BizWest convened discussion. They discussed the recently adjourned Colorado legislative session, the Affordable Care Act, workforce issues, consolidation in the industry and direct primary care.

SPONSORED CONTENT

Exploring & expressing grief

Support groups and events, as well as creative therapies and professional counseling, are all ways in which Pathways supports individuals dealing with grief and loss.

Legislation

Medical professionals were in agreement about one thing with the legislative session that ended last week: The speed at which things happened made it difficult to keep up.

Kevin Unger, president and CEO of UCHealth Poudre Valley Hospital and UCHealth Medical Center of the Rockies, said “things were proposed on a Thursday and voted on Monday. Good policy doesn’t come at the speed of light, he said.

Margo Karsten, Northern Colorado CEO for Banner Health, agreed. “We didn’t find our voice quickly enough to affect legislation.”

Still, said Unger, “We ended up in a decent place. As an industry we need to get tighter and figure out how to react to these things. We were on our heels most of this session.”

A measure intended to cut health-insurance premiums, especially on the Western Slope, by assessing a reinsurance fee on hospitals that will be used to fund health care of high-cost patients, did pass, Karsten said. “They won’t call it a tax but it is a tax. It will cost Banner $600,000, and we’re not a large operator,” she said.

Holly Kortum, executive director for Kaiser Permanente in this region, said Kaiser was particularly interested in the legislation that addressed surprise billings.

The measure passed was meant to correct situations in which a patient is presented with a large, unexpected bill because someone providing services at a network facility might work for a provider that isn’t in the network. Insurance companies reimburse based upon in-network and out-of-network providers, and thus patients can be left on the hook for an unexpected cost.

“This (the new law) should be helpful for a member not getting caught by a surprise bill,” she said.

Companies such as Flood and Peterson, an insurance broker and employee-benefits company, said the focus on hospitals and insurance carriers may be wrong. “On the outside are companies that want transparency and want solutions that lower costs. By working employer by employer, we can get the quality of care we want and implement cost containment,” said Kendra Johnson, director of employee benefits solutions at Flood and Peterson. “Hospitals and physicians can join these efforts and work with employers and the broker to lower costs,” she said.

John Bender, CEO of Miramont Family Medicine, said a focus on primary care is important. He cited efforts elsewhere, Rhode Island for example, where insurers are required to devote a larger amount of their coverage to primary care, which can help reduce costs of the more-expensive specialty care and emergency care.

He said Colorado House Bill 1233 “will create a commission that will look at ways to increase utilization of primary care. At least there’s some movement.”

With health-care costs among the largest lines on many companies’ profit-and-loss statements, and cost control a major interest of new Gov. Jared Polis, discussion will continue in the Legislature.

“This is the topic of our careers — how do you drive down cost and improve quality,” Unger said.

While the governor’s agenda may be to move toward a single-payer system — Medicare for all — implementing that on a state level can be difficult, Unger said.

Johnson said the governor may be aware of that. He’s talking about how several western states can work together to drive down costs, she said.

“He has definitely been moving faster than we have been,” she said.

Affordable Care Act

With the White House continuing to push to eliminate the Affordable Care Act, also known as Obamacare, health-care professions are concerned about a return to volatility.

Kortum said, “The ACA did a lot of good things. It brought insurance to a lot of people who didn’t have it, and it was volatile [at the beginning.] The volatility has smoothed out; if it goes away, it will create more volatility. Where will people land if it goes away? In emergency rooms…,” she asked.

Karsten said the ACA “would be very hard to unravel at this point.”

Workforce

Like virtually every other industry in the region, finding and keeping quality workers is on the minds of health-care CEOs.

“At Good Samaritan, we’ve picked apart some jobs to see if some [functions] can be done without a professional certification. We also have a certified medication course going on now on our campus. Those folks help out the professional nursing staff doing med passes. It frees up nurses for other tasks” said Lisa Melby, executive director of Good Samaritan Loveland Village.

“We’re hiring resident assistants who can do the more manual things: making beds, passing water, moving residents around the facility. We’re also providing lots of scholarships and partnering with Careerwise,” she said. Careerwise is a program that creates traditional apprenticeships for long-term development of staff members.

Karsten said the rural market is more difficult than the more urban areas. Banner has a facility in Sterling, for example. “It’s [the problem] cross-clinical — certified and noncertified,” she said.

Unger complained about how the shortages in the building trades are affecting UCHealth, which is building a new hospital in Greeley. “Drywall, flooring, HVAC are our biggest issues. Give us the keys to the building…”

Bob Wilson, CEO of Columbine Health Systems, said educational institutions at one time provided licensed practical nurse certifications, but then stopped. “It’s taken us 10 years to get those programs reinstated,” he said. He described the current employment conditions as “the worst I’ve ever seen.”

Kortum said the employment situation for Kaiser is a little better than what it might be at a hospital because Kaiser doesn’t have to staff around the clock. New strategies such as video visits and chat-with-a-doc are changing how the organization staffs the operation.

Nate Lamkin, president of Pathways Hospice, said his agency has a difficult time competing against the larger facilities.

And larger facilities aren’t immune from issues, either. “Many younger workers want to work independent, not for a corporate entity. We’re trying to figure out what we can do about that,” Karsten said.

Melby said Good Sam has become more flexible with work shifts. Some want to work three 12-hour days during the week; others may want to work four hours a day. “You have to be flexible,” she said.

Dan Karpel, CEO of the Eye Center of Northern Colorado, said, “We spend a great deal of time and energy trying to figure out how to recruit and retain. In our world there’s a lot of certifications that we require. We have to decide whether we need to require that, and what does that mean to the quality of care.”

He also said that generational changes affect how companies operate. Quoting a human resources professional, he said, “we live in a day and age  

where we have to thank people for arriving [for work.]”

Craig Luzinski, CEO of Associates in Family Medicine, said the times require different approaches. “We used to just post a job. Now, we have to recruit and retain,” he said. He also said there are things clinics and others can do to fill positions. Patients can schedule their appointments online without going through a scheduler, for example.

Kari Bettermann, administrator of the Rocky Mountain Family practice, said she’d like a solution to the mounds of paperwork required by insurance companies.

“If you don’t participate in a certain payment model there will be a penalty. Requirements keep piling up, piling up, piling up,” she said.

Jim LaBorde, administrator of the Centers for Gastroenterology, concurred with Bettermann, saying the amount of time staff members spend on hold with insurance companies is enormous.

LaBorde’s clinic has taken the step of allowing some employees to work from home. “Does a coder have to be in the office every day? We’ve had good success with that [letting that person work from home]. Home workers have the added benefit for the company of reducing the amount of office space needed, he said.

Blake Sims, the new CEO of the Northern Colorado Long Term Acute Hospital in Johnstown, said the lack of quality applicants calls for different approaches. And sometimes those approaches don’t work, he said, describing a situation where he tried to recruit a hotel customer service worker only to have her not show for the interview.

Acquisitions

Some members of the discussion group expressed concerns about acquisitions in the health-care industry.

Karpel said acquisitions, while they are occurring locally involving hospitals and clinics, said he’s more concerned about the insurance perspective. “We should all be concerned about the consolidation in that area,” he said, referring to insurance companies that have been buying up pharmaceutical companies and suppliers. He sees those acquisitions as driving up prices for patients while deriving huge profits for stockholders.

Direct primary care

Colorado ranks among the leaders in the country with health-care professionals offering care directly to patients without an insurance company involved. Yet, according to Bender, those practices aren’t large enough to be sustained. He said the average direct primary care doctor has about 350 patients when 600 is the break-even point.

Johnson said F&P as an insurance broker is working to connect physician groups with employers to set up direct care without insurance. “If you have a relationship with the direct primary care physician you can drive down costs,” she said.

Employers may need to take a chance, Luzinski said. Employers need a care manager, because neither the employer or the employee understands health care. “We have to insert ourselves into that role,” he said.

BizWest’s CEO Roundtables are sponsored in Northern Colorado by EKS&H now part of Plante Moran, Elevations Credit Union and Flood and Peterson.